7 best practices to curb costly emergency care

A plan implemented by Washington state's Medicaid program and a coalition of providers cut emergency department (ED) use and the rate of ED-related scheduled drug prescribing by an estimated $33 million, according to a report by the Washington State Health Care Authority.

Claims data for fee-for-service and managed care beneficiaries showed the rate of ED visits dropped by 9.9 percent in fiscal year 2013, the report stated. The rate of frequent ED visitors fell by 10.7 percent, the rate of visits resulting in a scheduled drug prescription dipped by 24 percent and the rate of visits for low-acuity diagnoses decreased by 14.2 percent.

Payers have grappled for years with the problem of wasteful healthcare spending casued by inappropriate ED use. And a recent study published in the Annals of Emergency Use found Affordable Care Act implementation may drive ED visit rates up even more. In light of these trends, Washington's program may offer a utilization management prototype.

While the report acknowledged the program's savings can't be attributed solely to best practices, they nevertheless contributed to lower ED spending. The practices include:      

  1. implementing an electronic system to exchange patient information among hospitals statewide;
  2. educating patients on the difference between emergencies and nonemergencies;
  3. helping hospital staff recognize frequent ED visitors;
  4. implementing systems to refer nonemergency patients to primary care providers within three or four days;
  5. adopting stricter guidelines for prescribing narcotics in EDs;
  6. enrolling at least 90 percent of ED prescribers in the state's prescription drug monitoring program; and
  7. ensuring that ED staff receive regular progress reports and act to correct any utilization problems the reports reveal.  

These practices don't aim to block access to services but rather to coordinate healthcare more effectively, The Seattle Times reported.

Washington's program invovled a collaboraion among the state's Health Care Authority, hospital association, medical association and the Washington Chapter of the American College of Emergency Physicians.

"This program demonstrates the power of public-private partnerships to improve care, control costs and develop a better healthcare system for all," said Nathan Schlicher, M.D., J.D., in an announcement.

For more:
- here's the report (.pdf)
- read The Seattle Times article
- see the Washington State Health Care Authority's announcement

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